Social Work Today E-Zine

When the death of Freddie Mac chief financial officer David Kellerman looked to be a suicide, people wondered whether it was driven by economic stress. In a recession this severe, people ask, does the suicide rate go up? The sad truth is, nobody knows.

Thanks to the power of modern disease surveillance, we can watch flu pandemics unfold before our eyes, minute by minute. Yet there is no equivalent way to monitor suicides.

“People everywhere are wondering if suicides are spiking in response to economic woes, yet we have no reliable system for tracking suicide rates in real-time,” says Matt Wray, PhD, a sociologist at Temple University and a former Robert Wood Johnson Foundation Health and Society Scholar at Harvard University.

“There are good reasons to believe rates are rising—perhaps even sharply—but there is no way to know for sure,” he says. According to Wray, official data on suicides are collected by counties and states and forwarded to the National Center for Health Statistics for aggregation and public release, but this is a labor-intensive and time-consuming process. The last year for which national suicide statistics are available is 2005. Under the present reporting system, it will be 2012 or later before we know what happened during the 2008-2009 recession.

However, the questions surrounding David Kellerman’s tragic death make a few things clear, asserts Wray. “With 30,000 Americans each year taking their own lives, we need a national system for better and more timely suicide reporting. The National Violent Death Reporting System, run by the Centers for Disease Control, is a step in the right direction, but this program has been slow to expand—only 17 states are currently involved—and data still take about three years to process. I think the new administration ought to find a way to use stimulus funding to improve on that.”

— Source: Temple University

Mothers of multiples have 43% increased odds of having moderate to severe depressive symptoms nine months after giving birth compared with mothers of single-born children, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined the relationship between multiple births and maternal depressive symptoms and found that multiple births increased the odds of maternal depression. The results are published in Pediatrics.

“Our findings suggest that 19% of mothers of multiples had moderate to severe depressive symptoms nine months after delivery, compared to 16% among mothers of singletons,” says Yoonjoung Choi, DrPH, lead author of the study and a research associate with the Bloomberg School’s department of international health.

Choi and colleagues used data from the Early Childhood Longitudinal Study—Birth Cohort, a nationally representative sample of children born in 2001. They measured depressive symptoms in mothers using an abbreviated version of the Center for Epidemiologic Studies Depression (CES-D) scale. Researchers examined the association between multiple births and maternal mental health. They also found that, among the mothers of both singleton and multiples, only 27% reported talking to a mental health specialist or a general medical provider when experiencing depressive symptoms.

“The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms,” says Cynthia Minkovitz, MD, MPP, senior author of the study and an associate professor with the Bloomberg School’s department of population, family and reproductive health. “Pediatric practices should make an additional effort to educate new and expecting parents of multiples regarding their increased risk for maternal postpartum depression. Furthermore, well-child visits are potentially valuable opportunities to provide education, screening and referrals for postpartum depression among mothers of multiples.”

— Source: Johns Hopkins Bloomberg School of Public Health

Family conflict, drug or alcohol use and pre-existing suicidal thoughts were the strongest predictors of suicidal events among adolescents whose depression treatment was changed after a lack of response to a previous medication.

The findings were reported today in the article "Predictors of Spontaneous and Systematically Assessed Suicidal Adverse Events in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study," at AJP in Advance.

In the study, 334 adolescent patients who had not responded to a selective serotonin reuptake inhibitor were switched to a different SSRI or to venlafaxine, with or without cognitive-behavioral therapy. Forty-eight patients experienced a suicidal event-suicidal ideation (new or worsening), a suicidal threat or a suicide attempt. The median time from a suicidal threat to a suicidal event was three weeks. In the article, lead author David Brent, MD, and colleagues recommend careful monitoring of more severely depressed adolescent patients who have high levels of suicidal thoughts or family conflict.

Treatments that target family conflict and emotion regulation early may help reduce suicidal events. Likewise, since the predictors of suicidal events also predict poor treatment response, targeting family conflict, suicidal ideation and drug use may hasten response and help to reduce the incidence of these events.

— Source: American Psychiatric Association

Following a psychiatric discharge, Medicare patients in insurance plans that provide equal cost sharing for mental health services have higher use of those services compared with patients in plans that require greater cost sharing, according to a study in The Journal of the American Medical Association.

The researchers examined the relation between parity in outpatient cost sharing and whether enrollees had an outpatient mental health visit within 7 and 30 days following a hospitalization for mental illness. Among 43,892 enrollees in 173 health plans who were hospitalized for a mental illness, the relation of parity in cost sharing and receipt of timely outpatient mental health care after discharge was determined analyzing 10 plans that discontinued parity compared with 10 matched control plans that maintained parity.

The researchers found that individuals in full-parity plans were more likely to visit a mental health practitioner within 7 and 30 days after a hospitalization compared with enrollees in plans with intermediate or no parity. For example, copayments that were $14 greater in plans without parity compared with full-parity plans were associated with an 11 percentage point lower rate of follow-up after a psychiatric hospitalization. Rates of follow-up visits within 30 days decreased by 7.7 percentage points in plans that discontinued parity and increased by 7.5 percentage points among control plans that maintained parity.

“Most Medicare health plans, like most commercial health plans, have unequal coverage for mental health services compared with other medical services. Enrollees in plans without parity in cost sharing are less likely to receive timely outpatient care following a hospitalization for mental illness. While prior studies have shown that adoption of mental health parity does not increase mental health spending, parity legislation that equalizes cost sharing for mental health and primary care may increase the use of clinically appropriate mental health services,” the authors concluded.

— Source: American Medical Association

People who have a sibling with a mental illness are more likely to suffer episodes of depression at some point in their lives, say researchers who analyzed four decades of data. The data for this study were obtained from the 46-year Wisconsin Longitudinal Study. Additionally, they found people with a sibling with low IQ are more likely to live near that brother or sister—but be somewhat emotionally detached from that sibling, according to the findings in the Journal of Family Psychology.

“So little is known about the impact that a person with low IQ or mental illness has on the psychological and social development of his or her siblings, especially beyond childhood,” says the study’s lead author, Julie Lounds Taylor, PhD. “Our findings highlight the need for families of the mentally ill, specifically siblings, to be more aware of their own mental health needs throughout their lifetimes.”

The researchers identified 351 people who had at least one sibling with a mental disability, which were later broken into two groups: those whose siblings had a mental illness and those whose siblings had a low IQ. The researchers also looked at results from a comparison group of 791 people who did not have a sibling who was mentally disabled.

The researchers found people who had siblings with mental illnesses were 63% more likely to report having a depressive episode during their lifetime. They also found the brothers and sisters of the people with low IQs were 18% more likely to live in the same state as the disabled brother or sister than those in the comparison group. However, they were significantly less likely to have contact with the disabled sibling, reporting an average of 13 fewer contacts a year with their disabled sibling than the comparison group. In addition, they reported feeling less emotionally close to their siblings.

The researchers also found those who had a brother with a mental illness had lower levels of psychological well being than those in the comparison group. They did not see this effect when looking at those who had a sister with a mental illness. This suggests genetics may not be the only link to poor mental health among siblings of the mentally ill, but the social relationship is also important.

— Source: American Psychological Association

Counseling and social support are key to alleviating depression for family caregivers, even when their relatives with Alzheimer’s disease receive pharmacologic treatment. These findings are reported in a recent issue of the American Journal of Geriatric Psychiatry. 
According to lead author Mary Sherman Mittelman, DrPH, of The William and Sylvia Silberstein Institute for Aging and Dementia at New York University (NYU) Langone Medical Center, the study looked at change in symptoms of depression in a total of 158 pairs of spouse-caregivers and patients with Alzheimer’s disease. 


All the Alzheimer’s patients were prescribed donepezil at no cost while they participated in the study. One half of the caregivers were given a comprehensive psychosocial intervention that included two individual and three family counseling sessions within three months of enrolling in the study, and counseling on demand for two years after enrolling, generally on the telephone; caregivers in the control group only received resource information upon request. Symptoms of depression in the caregivers were measured at intake and at follow-up assessments conducted at regular intervals for 24 months.

Over the two years they were in the study, symptoms of depression decreased among caregivers who received the five sessions of individual and family counseling, while depression increased among those who did not receive counseling. The results provide evidence that a multicomponent counseling and support program for caregivers can have significant benefits in reducing symptoms of depression in caregivers whose spouses are taking donepezil.

— Source: New York University Langone Medical Center

The University of North Carolina (UNC) at Chapel Hill is leading a novel clinical trial to compare the effectiveness of online cognitive behavioral therapy (CBT), delivered through a Web site and augmented with therapist-moderated, weekly online chat sessions, to face-to-face group therapy for the treatment of bulimia nervosa.

“For individuals with bulimia nervosa … face-to-face cognitive behavioral therapy or CBT has long been considered the gold standard of treatment,” says Cynthia M. Bulik, PhD, the study’s principal investigator and director of the UNC Eating Disorders Program.
The Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center will also take part in the study. Marsha D. Marcus, PhD, professor of psychiatry and psychology and service chief of the Center for Overcoming Problem Eating, is the principal investigator at the Pittsburgh site. 


Unfortunately, for several different reasons CBT does not reach everyone who needs treatment. “As a way to overcome these challenges,” Bulik says, “we’ve developed a Web site that will deliver the same content as traditional, manual-based cognitive behavioral therapy, but it will take advantage of all the bells and whistles—such as sound, animation, and video—that make the best Web sites so compelling.”



Bulik and colleagues plan to recruit 180 people with bulimia nervosa to take part in the study: 90 at UNC and 90 at Pittsburgh. One half will be randomized to receive CBT with weekly face-to-face group therapy sessions over a 20-week period. The other half will receive Web-based CBT with weekly online group therapy chat sessions. To measure the effectiveness of the intervention, follow-up assessments on each participant will be conducted at 3, 6, and 12 months after the end of treatment.

Marcus says, “If [online treatment] is as effective as CBT delivered in an in-person format, we will be able to provide CBT to individuals who currently are unable to obtain specialty care for the disorder.”

— Source: University of North Carolina at Chapel Hill School of Medicine